Pojęcie „ciężkiego uszczerbku na zdrowiu” a obowiązek prawny zawiadomienia organów ścigania

The obligation of physicians and other health professionals under Art. 240 § 1 of the Criminal Code instructs them to notify the law enforcement authority responsible for prosecuting crimes (in particular the Police or public prosecutor’s office) when prohibited acts are committed, attempted, or prepared. The list of such acts is enumerative, indicating the numbers of the relevant articles and paragraphs. On 13th July 2017 Art. 156 of the Criminal Code extended the list, adding grievous bodily harm as a prohibited act. Accordingly, this act introduced the legal obligation of denunciation, which outweighs medical privacy in such situations. As it can be difficult for a clinician to identify which injuries meet the criteria of grievous bodily harm, the authors of the paper have described in detail all of its forms with specific examples, since failure to comply with that obligation is punishable by up to three years of deprivation of liberty.Na lekarzach i innych pracownikach medycznych spoczywa obowiązek prawny wynikający z art. 240 § 1 Kodeksu karnego (k.k.), który nakazuje im zawiadomić organ powołany do ścigania przestępstw (tj. Policję lub prokuraturę) o dokonanym czynie zabronionym, jak również o jego karalnym przygotowywaniu lub usiłowaniu. Wykaz czynów podlegających takiej denuncjacji został podany enumeratywnie, ze wskazaniem numerów artykułów i paragrafów. Wyliczenie to zostało rozbudowane w wyniku nowelizacji k.k. dokonanej 13 lipca 2017 r. W jej wyniku do tego katalogu dodano art. 156 k.k., w którym spenalizowany jest ciężki uszczerbek na zdrowiu. Tym samym czyn ten został objęty prawnym obowiązkiem denuncjacji, który jest w takiej sytuacji ważniejszy niż tajemnica medyczna. Z uwagi na to, że dla lekarza klinicysty rozpoznanie, jakie obrażenia spełniają znamiona ciężkiego uszczerbku na zdrowiu, może być trudne, autorzy niniejszej pracy szczegółowo omówili wszystkie jego postaci z podaniem konkretnych przykładów, biorąc pod uwagę, że niewykonanie tej powinności jest zagrożone karą pobawienia wolności do lat 3

Experimental Studies on Post-Explosion Lesions in a Model of Human Soft Tissues

Descriptions of blast-related injuries have long been established in the textbooks. Since, for obvious reasons, it is difficult to perform ballistic studies on human tissues, such research is usually conducted on appropriate models, i.e., gelatin blocks and soap blocks each of these materials has distinctive properties, which make them suitable for unique applications. The work aims to present the possibilities for analyzing the effects of explosion on the human body using a ballistic soap model. The tests performed allow to conclude that a shock wave affects the surface of the ballistic soap block, generating hemispherical craters, which begin to overlap when the distance between the explosive charge and block is reduced, until they form one semi-cylindrical hollow (when linear charge is used), which represents a temporary cavity. The results obtained allow for an assessment of the extent of post-explosion lesions

Thoracolumbar fascia in the lumbar region: anatomical description and topographical relationships to the cutaneous nerves: a preliminary study

Background: The study aims to determine principal topographical relations between thoracolumbar fascia (TLF) and lateral branches derived from the dorsal (posterior) rami of lumbar spinal nerves and elucidate their potential link to lumbar region pain. The research protocol involves basic TLF morphological description, evaluating its relation to the nerves, and examining general histology. Materials and methods: The research was conducted on four male cadavers fixed in 10% neutral buffered formalin. Results: The dorsal rami of the spinal nerves branched into medial and lateral divisions. The lateral divisions were about 1 mm thick and mainly visible in the subcutaneous tissue during stratigraphic dissection. They pierced the TLF superficial layer. They descended sidewards and downwards within the superficial fascia (laterally to the erector spinae muscle) to provide sensory innervation to the skin. Conclusions: Anatomical relationships between TLF, deep (intrinsic or true) back muscles, and dorsal rami of the spinal nerves are complex and may be clinically involved in low back pain etiopathogenesis

Perfect crimes

A crime can, in fact, be perfect in very different ways, and this perfection indeed depends only on the aim of the perpetrator, whose psychic does not always work in a conventional way. Therefore, this phenomenon cannot be simply described. Numerous publications in the field of forensic medicine, in which the keyword „perfect crime” appears, certainly do not exhaust the topic, because they are mostly only interesting speculations on the possibility of demonstrating certain causes of fatal events during a criminal investigation. The purpose of the study was to present a few such publications from 1995-2020 and to analyze how the gathered evidence, research capabilities, and the inquisitiveness of state prosecutors and experts could have influenced the results of investigations. An undeniable fact was determined: the stronger the data gathered, the larger the research capacities, and the greater the curiosity of the investigators, the smaller the chances for committing a perfect crime. And vice versa. Some events, however, have such a high potential to become a perfect crime that the chances of discovering the truth do not exist, or they arise only as a result of an accidental coincidence

Amphetamine-related myocardial infarction in a 42-year old man

Myocardial infarction is an infrequent condition in young adults. In most cases, it occurs due to causes other than atherosclerosis of the coronary arteries, including blood hypercoagulability, congenital anomalies of the coronary arteries, their inflammation or spasm induced by amphetamine or cocaine use. Amphetamine and its derivatives, via increasing the levels of epinephrine, serotonin and dopamine in the central nervous system, exert their effect also on the cardiovascular system, causing coronary spasm, enhancing platelet aggregation and inducing tachyarrhythmias. The paper presents a case of a 42-year-old man admitted to the emergency department because of emaciation and dehydration. The man was conscious, without contact, with a significant elevation of body temperature and tachycardia. On the basis of examinations, a fresh infarction of the anterolateral wall of the heart was diagnosed and the patient was transferred to a cardiac intensive care unit. There, laboratory tests revealed significantly elevated markers of myocardial necrosis and the presence of amphetamine in blood and urine. In spite of the institution of treatment the patient developed cardiorespiratory arrest. Advanced resuscitation procedures were undertaken, however, they proved unsuccessful. The presence of an infarction focus was confirmed in autopsy. Toxicological analysis of the blood for the presence of alcohol-like substances detected amphetamine at a concentration of 269.5 ng/ml. After examining the complete body of evidence it was established that the patient had died of acute cardiorespiratory failure secondary to an extensive fresh myocardial infarction. As indicated by the accumulated data, the most probable cause of myocardial infarction was amphetamine poisoning

Constraints Applied to Persons with Mental Disorders – Conflicting Legal Acts

Kolizja przepisów ustawy o środkach przymusu bezpośredniego i broni palnej oraz ustawy o ochronie zdrowia psychicznego prowadzi do możliwości kwestionowania legalności działań Policji wobec osób z zaburzeniami psychicznymi. Taka sytuacja jest niedopuszczalna i wymaga zmian legislacyjnych. Nie do pomyślenia jest bowiem, aby policjant nie miał wskazanego jasnego sposobu postępowania, a kontrola jego działań została oparta na niejednoznacznych przepisach w tym obszarze.In democratic states of law, personal freedom is legally protected, and in Poland it is guaranteed in the constitution. Limitations on freedom are allowed only in exceptional cases, when it necessary to protect other valuable interests. Limitations can be justified on the basis of the need to protect safety or public order, health or freedom, and the rights of other persons. A collision between freedom and such interests can occur in the case of dangerous behaviours of persons with mental disorders. That is why the Polish legislator has introduced legal norms that allow for interference in such a situation. The issue is discussed in the act on the protection of mental health which in Articles 18–18f regulates the binding procedures and the competence of persons who apply constraints. However, the act on direct coercive measures and firearms is binding for officers of the police and other services, which provides for different coercive measures and sets forth the rules for their application. Therefore a collision occurs between these two acts of law. In their article, the authors present the colliding areas and propose ways to solve the issues stemming from these collisions. The possibility for an officer to refer to the state of necessity has been also discussed

Recommendations on Police Intervention - Measures Applied to Persons with Mental Disorders

W interwencje Policji wobec osób z zaburzeniami psychicznymi wpisana jest nieprzewidywalność, ale właściwe działanie i współpraca z personelem medycznym może zminimalizować ryzyko niepomyślnego zakończenia, co jednak wymaga zmodyfikowania typowych zasad reagowania. Pełne zrozumienie tytułowych zagadnień wymaga przedstawienia także kilku dodatkowych kwestii, takich jak: excited delirium, uduszenia gwałtowne, obchwyt szyi, szkolenia i obowiązek udzielenia pomocy oraz stwierdzanie zgonu. Artykuł przybliża je i wskazuje prawidłowy sposób postępowania Policji w razie interwencji wobec osób z zaburzeniami psychicznymi.Police interventions in the case of persons with mental disorders are inseparably associated with unpredictability, however appropriate measures and cooperation with medical staff may reduce the risk of unfavourable events, which, however, calls for modification of typical reactions. In order to understand these issues thoroughly, it is necessary to present them as: excited delirium, agitated delirium, acute behavioural disturbance/disorder, violent strangling, neck grip, training on providing assistance and obligation to provide assistance, as well as to declare somebody dead. In the article, all these issues have been discussed as well as the proper manner for the police to proceed in the case of intervention with the participation of persons with mental disorders. Because the detailed rules on how to proceed have been frequently published by the authors, they are not repeated in this article – it is only indicated where these can be accessed. Still, the authors refer to the opinion of the Physicians for Human Rights that in March 2022 published a stance questioning the notion of excited delirium – the article presents the origins and evolution of the notion, as well as the reasons for questioning it today. The authors claim that declaring somebody dead due to excited delirium is a diagnosis with exclusion, i.e. made if other reasons have been excluded – the basic disease, injury or poisoning have not been stated that would clearly expla in the reason of death. Excited delirium does not give any pathognomonic symptoms during autopsy (which would allow for confirming such a diagnosis)

Bezobjawowa aspiracja wiertła stomatologicznego do dolnych dróg oddechowych – opis przypadku

W niniejszej pracy przedstawiono przypadek mężczyzny, u którego podczas leczenia stomatologicznego doszło do bezobjawowej aspiracji wiertła stomatologicznego do dolnych dróg oddechowych. Brak jakichkolwiek objawów aspiracji ciała obcego mylnie zasugerował lekarzom połknięcie i przedostanie się go do żołądka, co nie zostało wykluczone kontrolnym zdjęciem radiologicznym klatki piersiowej. Dopiero kolejne badania obrazowe umożliwiły postawienie właściwego rozpoznania i usunięcie ciała obcego drogą torakotomii lewostronnej